[Irritable bowel syndrome and functional dyspepsia : Diagnosis and treatment]. / Reizdarmsyndrom und funktionelle Dyspepsie : Diagnostik und Therapie.

Irritable bowel syndrome (IBS) and functional dyspepsia are chronic diseases of the digestive tract that challenge both patients and physicians due to their difficult diagnosis and limited treatment options. The international Rome IV diagnostic criteria are commonly used for research purposes. For IBS, the diagnostic criteria based on the German S3 guideline offer a less complicated alternative for everyday clinical practice. A thorough history and basic diagnostic work-up are essential for diagnosis, as reliable biomarkers are still lacking. Clinical manifestations of both disorders are variable, and it has been useful to allocate subtypes based on leading symptom clusters; these may facilitate the choice of diagnostic tests as well as symptomatic treatment approaches. Used correctly, the combination of available drug (mostly off-label) and non-drug options can help to reduce symptoms and improve quality of life.

Determinants and frequency of irritable bowel syndrome in a German sample.

BACKGROUND: To date there is no study that has estimated the prevalence of irritable bowel syndrome (IBS) in Germany according to the current Rome III criteria. The aim of the present study was to investigate the prevalence of IBS in a non-clinical German sample. Furthermore, we investigated the association of IBS with socio-demographic and psychological risk factors. METHODS: Baseline data from a prospective cohort study were analysed, including the IBS Module of the Rome III Diagnostic Questionnaires and validated psychometric scales including the Patient Health Questionnaire-15 (PHQ-15), the Big Five Inventory (BFI), the Perceived Stress Questionnaire (PSQ-5), and the Whiteley-Index (WI-7). The study population was compared to the German general population to appraise its representativeness. Multivariate logistic regression analyses were performed to identify possible risk factors associated with IBS. RESULTS: Between January 2011 and September 2012, 2419 persons participated (female 54.0 %, mean age 37.4 ±â€Š14.9 years). According to the Rome III criteria, 401 participants (16.6 %) suffered from IBS. Five predictors were independently associated with IBS: previous traveller's diarrhoea infection (OR = 1.76; 95 % CI = 1.34 to 2.31), higher somatic symptom burden (OR = 1.15; 95 % CI = 1.07 to 1.23), increased level of hypochondriasis (OR = 2.04; 95 % CI = 1.54 to 2.70), increased vulnerability to diarrhoea under stress (OR = 3.88; 95 % CI = 3.21 to 4.68) and perceived stress (OR = 1.43; 95 % CI = 1.04 to 1.99). CONCLUSIONS: Our analyses yielded a relatively high IBS prevalence estimate, compared to studies published more than ten years ago. This might partially be explained by the fact that the time criterion of the Rome III criteria (at least 3 days/month in last 3 months) is more inclusive compared to the time criterion of the Rome II criteria (at least 12 weeks, which need not be consecutive, in the preceding 12 months).

[Therapeutic monitoring of antibiotics: New methodologies: biosensors]. / Monitorización terapéutica de antibióticos: Nuevas metodologías: biosensores.

The pharmacokinetics of antibiotics, especially in severely ill patients, may be profoundly altered due to multiple pathophysiological changes. Recent studies have shown that empiric dosing recommendations for ICU patients are inadequate to effectively treat a broad range of susceptible organisms and need to be reconsidered. Therapeutic drug monitoring (TDM) is an important mean for optimizing drug utilization and doses for the purpose of improving the clinical effectiveness. However, it is very challenging to quantify plasma antibiotic concentrations in clinical situations as a routine practice, because of the high costs and complexities associated with advanced instrumental techniques. Currently there are not routine and low cost methods to determine the presence and concentration of ß-lactam antibiotics in plasma patients in a clinical setup. Indeed, such analytical methods are based on chromatographic techniques mainly used in research. Here we describe and comment different techniques, focusing on our preliminary experience using biosensors.

[Thrombolytic therapy for submassive/ intermediate risk Pulmonary Embolism Evidence and suggestions after PEITHO trial]. / Terapia trombolítica en TEP submasivo/riesgo intermedio: Evidencias y sugerencias post estudio Pulmonary Embolism Thrombolysis (PEITHO).

Therapy for submassive pulmonary embolism (intermediate risk), remains controversial. New evidence has appeared that may help us in the process of decision making. We review the relevant literature, outline prognostic factors, and discuss current recommendations and controversies regarding the available alternatives such as systemic and catheter-directed thrombolytic use.

Terapia trombolítica en TEP submasivo/riesgo intermedio: Evidencias y sugerencias post estudio Pulmonary Embolism Thrombolysis (PEITHO) / Thrombolytic therapy for submassive/ intermediate risk Pulmonary Embolism Evidence and suggestions after PEITHO trial

Therapy for submassive pulmonary embolism (intermediate risk), remains controversial. New evidence has appeared that may help us in the process of decision making. We review the relevant literature, outline prognostic factors, and discuss current recommendations and controversies regarding the available alternatives such as systemic and catheter-directed thrombolytic use.

Aspergilosis traqueobronquial necrotizante en paciente crítico / Necrotizing tracheobronchial aspergillosis in an immunosuppressed patient. Report of one case

Necrotizing tracheobronchitis due to Aspergillus spp is a rare form of invasive aspergillosis. This infection is limited to or predominant in the bronchial tree. The clinical evolution is gradual: from mild non-specific manifestations of acute tracheobronchitis to severe acute respiratory insufficiency determined by a bronchial obstruction syndrome. We report a 38 years old female with systemic lupus erythematosus treated with methylprednisolone and cyclophosphamide. She developed an invasive aspergillosis, severe respiratory failure with predominant tracheobronchial damage and upper respiratory complications.

Quality of life one year post-Shiga toxin-producing Escherichia coli O104 infection--a prospective cohort study.

BACKGROUND: In 2011, a major outbreak of hemolytic-uremic syndrome (HUS) and bloody diarrhea related to infections from Shiga toxin-producing Escherichia coli O104 (STEC) occurred in Germany. While previous research has focused on the medical components of this disease, we aimed to investigate the course of health-related quality of life (HrQoL) over 12 months including somatic and psychosocial risk factors. Furthermore, the influence of chronic fatigue (CF) on HrQoL was examined. METHODS: A prospective cohort study with n = 389 patients completing self-report scales at baseline, after 6 months (participation rate: 79%) and after 12 months (participation rate: 77%). The courses of physical and mental HrQoL over the 12 month period were calculated by employing general linear mixed models. KEY RESULTS: While the physical component score of HrQoL reached a score comparable to the general population, the mental component score remained below average 12 months after STEC infection. Female gender, prior psychiatric disorder, and prior traumatic events were risk factors for a worse HrQoL course after 12 months, while social support was identified to be protective. CF was associated with low HrQoL. In addition, the somatic symptom burden remained persistently high. CONCLUSIONS & INFERENCES: Our results show high somatic and psychosocial burden in patients 12 months after STEC infection. We recommend considering the risk factors and protective factors of poor HrQoL early in the treatment of STEC or similar diseases. Patients who are suffering from persisting somatic symptoms, CF, and impaired HrQoL may require specific aftercare.

[Pain therapy in irritable bowel syndrome]. / Schmerztherapie beim Reizdarmsyndrom.

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal diseases. It is characterized by chronic abdominal pain, typically associated with altered bowel habits that cannot be explained by structural abnormalities in routine diagnostic workup. Based on the predominant symptom, IBS can be divided into different subtypes: IBS with predominant constipation, diarrhea, bloating, or pain. Knowledge about the complex and multifactorial IBS pathophysiology has increased tremendously in recent years, e.g., IBS may be related to alterations in gastrointestinal motility, visceral sensitivity, and the mucosal immune system. It is important, both for the patient and the physician, that IBS diagnosis is made quickly and thoroughly based on the typical symptom complex and exclusion of relevant differential diagnoses and to reassure the patient that IBS is a chronic, but benign disease. These components are the fundamental basis for a good patient-physician relationship and for a successful long-term management of this potentially very compromising disorder. IBS therapy is based on general measures as well as symptom-oriented medical therapy, where improvement of abdominal pain is one of the main goals in treating IBS patients. Several pain treatment options are available, which may be used long-term or on demand and which may be combined with other therapies. General medical approaches include antispasmodics, improvement of bowel function, phytotherapy, and probiotics. Especially in patients with psychological comorbidities, antidepressants may be used. Modern drug treatments include the GC-C agonist linaclotide in IBS with predominant constipation, the locally acting antibiotic rifaximin in IBS with bloating, and 5-HT3 antagonists in IBS with predominant diarrhea. Psychotherapy should be included in an interdisciplinary approach in refractory cases or in psychological comorbidity.

[Efficacy of freeze-dried Lactobacilli in functional diarrhoe: a pilot study]. / Wirksamkeit eines Lactobazillen-Lyophilisats bei funktioneller Diarrhoe: eine Pilotstudie.

BACKGROUND AND OBJECTIVE: The pathogenic role of the intestinal milieu for symptoms in functional bowel disorders such as functional diarrhea (FD) or associated pain and bloating in the irritable bowel syndrome (IBS) is the rationale for probiotic treatment approaches. It was the aim of this pilot study to test the effects of a lyophilisate from devitalized lactobacilli and their culture medium in patients with chronic FD. METHODS: Following a one-week basal period, 22 patients mit FD (12 with IBS) were treated with Lacteol (2 capsules/day) for 4 weeks. Stool frequency, consistency (assessed by BSFS), urge, pain and bloating were recorded daily using a standardized symptom diary, and global relief was recorded weekly. RESULTS: Daily stool frequency and number of days with urge were significantly decreased starting in week 1 (-0.6 ± 0.2/day; p = 0.005; and -1.3 ± 0.3 days, respectively; p = 0.001). This effect persisted throughout week 4 (-0.6 ± 0.2/day; p< 0.02; and -1.4 ± 0.5 days, respectively; p = 0.025). After 4 weeks, 50% of patients reported satisfactory symptom relief, including improvement in maximal stool consistency (BSFS: -0.3 ± 0.2; p = 0.04), and 43% of patients recorded a decrease in stool frequency of ≥ 25%. CONCLUSION: These findings suggest a clinically relevant efficacy of Lacteol in a subgroup of patients with FD, particularly with regard to stool frequency, urge and stool consistency. As the study design does not allow to exclude that a placebo component might have contributed to these effects, the results should be corroborated in an larger, placebo-controlled trial.

Review article: rifaximin, a minimally absorbed oral antibacterial, for the treatment of travellers' diarrhoea.

BACKGROUND: Travellers' diarrhoea, a common problem worldwide with significant medical impact, is generally treated with anti-diarrhoeal agents and fluid replacement. Systemic antibiotics are also used in selected cases, but these may be associated with adverse effects, bacterial resistance and drug-drug interactions. AIM: To review the clinical evidence supporting the efficacy and safety of the minimally absorbed oral antibiotic rifaximin in travellers' diarrhoea. METHODS: PubMed and the Cochrane Register of Controlled Clinical Trials (to January 2010) and International Society of Travel Medicine congress abstracts (2003-2009) were searched to identify relevant publications. RESULTS: A total of 10 publications were included in the analysis. When administered three times daily for 3 days, rifaximin is superior to placebo or loperamide; it is at least as effective as ciprofloxacin in reducing duration of illness and restoring wellbeing in patients with travellers' diarrhoea, both with and without identification of a pathogen, as well as in diarrhoea caused by Escherichia coli infection. Rifaximin demonstrates only minimal potential for development of bacterial resistance and for cytochrome P450-mediated drug-drug interactions, and its tolerability profile is similar to that of placebo. CONCLUSION: When antibiotic therapy is warranted in uncomplicated travellers' diarrhoea, rifaximin may be considered as a first-line treatment option because of its favourable efficacy, tolerability and safety profiles.

[Summary of the annual meeting of the German Society for Neurogastroenterology and Motility]. / Deutsche Gesellschaft für Neurogastroenterologie und Motilität e. V. - Zusammenfassung der Jahrestagung 2009.

The annual meeting of the German Society for Neurogastroenterology and Motility was held at Castle Hohenkammer from 27 (th) to 29 (th) of March 2009. A "Young Investigator Meeting" took place on Friday communicating basics about scientific work. During the two-day main symposium, basic researchers and clinical scientists from Germany, but also from Europe, USA, Australia and Egypt presented their results on studies of the function of the enteric nerve system, gastrointestinal motility, and functional disturbances of the GI tract. Basic researchers as well as clinical scientists discussed the study results. Both days included a review lecture: E. Muth (USA) talked about "The effects of stress on the GI system and its relevance for functional gastrointestinal disorders" and B. Niesler (Heidelberg) about "Serotonin receptors and irritable bowel syndrome - what are the causal relations?"

Current and novel therapeutic options for irritable bowel syndrome management.

Irritable bowel syndrome is a functional gastrointestinal disorder affecting up to 3-15% of the general population in western countries. It is characterised by unexplained abdominal pain, discomfort, and bloating in association with altered bowel habits. The pathophysiology of irritable bowel syndrome is multifactorial involving disturbances of the brain-gut axis. The pathophysiology provides the rationale for pharmacotherapy: abnormal gastrointestinal motor functions, visceral hypersensitivity, psychosocial factors, autonomic dysfunction, and mucosal immune activation. Understanding the mechanisms, and their mediators or modulators including neurotransmitters and receptors have led to several therapeutic approaches including agents acting on the serotonin receptor or serotonin transporter system, antidepressants, novel selective anticholinergics, alpha-adrenergic agonists, opioid agents, cholecystokinin-antagonists, neurokinin-antagonists, somatostatin receptor agonists, corticotropin releasing factor antagonists, chloride channel activators, guanylate cyclase-c agonists, melatonin, atypical benzodiazepines, antibiotics, immune modulators and probiotics. The mechanisms and current evidence regarding efficacy of these agents are reviewed.